Provider Demographics
NPI:1265775258
Name:JOHN P. GALE DMD, PC
Entity type:Organization
Organization Name:JOHN P. GALE DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:GALE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-548-3279
Mailing Address - Street 1:3380 OLD JEFFERSON RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30607-1480
Mailing Address - Country:US
Mailing Address - Phone:706-548-3279
Mailing Address - Fax:
Practice Address - Street 1:3380 OLD JEFFERSON RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30607-1480
Practice Address - Country:US
Practice Address - Phone:706-548-3279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN011333335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier